Information Collection

Consumer Audience Feedback Team Screener

IC 247684 under ICR 202111-0925-006 · OMB 0925-0769.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Consumer Audience Feedback Team Screener	Form and Instruction
1 Consumer Recruitment Screener Attachment 1 - Consumer Recruitment Screener 111021.docx	Form and Instruction
1 Consumer Recruitment Screener Attachment 1 - Consumer Recruitment Screener 111021.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Consumer Recruitment Screener	Attachment 1 - Consumer Recruitment Screener 111021.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.